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Archive for October, 2008

So now you are close to graduating from nursing school or you have graduated recently. Whichever the case, you will be in for a reality shock when you begin your career as a Registered Nurse. What do we mean by the term, “reality shock”? Well, like the term says, it is the reality that shocks us. The question you may ask is, “so there is a difference in the reality of being a student or graduate nurse”? The answer is an emphatic, YES! First of all, as a student nurse you were given assignments that were not beyond the scope of your practice or ability. In addition to that, you were working under your instructor’s license and whether or not you were aware, they kept a very close watch on you. Therefore, there was a safety net that always hovered beneath you in case you were to fall.

This is not the case as you take on the title, Registered Nurse. There is no safety net. You are out there by yourself, free to make decisions and make mistakes. With those decisions and mistakes you are also, FULLY ACCOUNTABLE. Now imagine yourself with eight or more patients. You may be asking yourself, “What do you mean eight or MORE patients?” Most student nurses never have more than six or seven patients and that is only at the very end of the program. Even then, the student nurses can delegate tasks to assistive personnel thereby lessening their work load. However, there will be time that you will be on a floor, without any assistive personnel, with more than eight patients and no one to rely on except yourself. To compound this scenario, there may be patients that have very critical care pathways that you must follow, incoming calls from patient’s families, doctor’s, operating room staff, and other collaborative care departments requesting information. Now, let’s stop this scenario in its tracks. You probably feel the stress building by just reading the previous passage. If so, don’t worry, it is a perfectly normal reaction. So, relax, and know that there are ways to ease this inevitable right of passage. Let’s take a look at some of the ways to help ease and deal with reality shock.

1. First of all, it is important to understand that, “reality shock” does indeed exist and you will come face to face with it. Knowing what you will face is most of the battle. The task at hand then becomes, knowing what steps to take and resources to use, and how to use them.

2. Learn as much as you can during your in-service training program, which usually lasts up to eight weeks or more. This means familiarizing yourself with every inch of your floor. Know where everything is located, from safety pins to I.V. tubing. You may never know when you may need it, NOW, and the worst thing that can happen is that you spend precious time looking for something as small as a safety pin.

3. Know, who the assisted personnel are, and know them by name and face. Find out who will be the ones that you will be working with during your shift. What usually happens during in-service training is that graduate nurses train on the main shift, which is most frequently days, before transferring to the shift that they have been hired to work. Therefore it is very important to know who you will be working with during your shift. Try also to develop a working relationship with the assistive personnel. Remember, it is not a popularity game, you are not out to make best friends. Your goal is quality patient care, and the patient comes first. Let your intentions be known that your number one goal is to give the best patient care that you have respect for the care team assistive personnel and are a willing and helpful body to them as well. In doing this, you will have disabled the invisible wall that exists between nurses and assistive personnel. That wall is the one entitled, I am a NURSE and you are ONLY an aide. One thing that you must strive for is to use an even tone of voice, and fairness when delegating. You must also remember the rights of delegation, which are as follows, a. the right task, b. the right person, c. the right communication, (must be clear and concise), d. the right feedback, (the person who is delegated the task must comprehend what it is that is asked of them and let the nurse know that they comprehend). By doing this you are ensuring that patient care will not suffer do to a personality glitch, which could have been avoided.

4. Know, know and KNOW where the Policy and Procedure manual is located on the floor. Part of your hospital in-service will include the introduction of the Policy and Procedure Manual. This is the manual that you will have to refer to many times for protocol from everything from changing out a Foley Catheter to transporting a patient to another floor. The final analysis will be in any investigation, “did the nurse use and follow the Policy and Procedure Manual?” You want to always be sure that you follow the rules and protocols contained in your institutions manual. Therefore, you should know where it is located and be familiar with how to look up various procedures and policies, particularly

5. The policy regarding medication errors. Most everyone makes them and it is crucial that you know what paperwork is required to be filled out. It will come in handy. You cannot just, “wing it”, when making a decision, you have to follow protocol.

6. Use assertive communication when interacting with doctors’. Assertive communication indicates that you are aware of yourself and your limitations as well as your liability to the patients that you care for. Using this form of communication with over assertive medical personnel will help you function to your maximum capability and earn respect as an independent care professional. {For more information on the uses and strategies concerning assertive communication, please refer to the text entitled, Nursing Today, Transition and Trends, by JoAnn Zerwekh, Jo Carol Claborn, 5th edition, Co. 2006, Saunders, Philadelphia.}

7. Ask questions. You will have time during your in-service training to ask questions and get answers. It is your right to do so. Remember, not knowing is not an excuse, and you do not want to be in a situation where there will be no-one to ask. This is not to say that you will know everything, but a least you are giving yourself a head start and a good solid foundation by knowing what you can. So don’t be afraid to ask. Also, know who your resources are, for questions that you may have on the shift that you will be working.

8. Find a mentor with whom you can relate. Try to find someone not only on the shift during training, but also on the shift that you will be working. It is nice to find someone who has the experience and understanding as well as someone that you can get along. There might be a time that you will want to call them in the middle of the night and vent your concerns, or just to have them give you positive input in your performance. Mentors are essential to the growth of a new nurse.

9. Lastly, Know, Know and Know, what your State Nurse Practice Act states. This Act, is your guideline for most all that you do as a Registered Nurse. Know it well.

Hopefully these tips will help to ease the reality shock that you will face during your transition from student nurse to full time graduate nurse. Remember, you can’t do it all. You are a welcome asset to your employer, but first and foremost an embodiment of all that Florence Nightingale stood for. Best wishes on your journey.

Today my friend passed away. Do you recall the WWII Vet with the left below the knee amputee. Well he was transferred to Hospice care, and died about a week later. It was said that his wife asked him for a kiss, and he said NO, I’ll give you two, and then he passed away. May God rest his soul. You know he stated to me that he never had any pain associated with his lung cancer, and even drove himself to Veterans hospital a couple of weeks prior. He will be missed.

Not everyone is an all A student. Accept yourself for the effort that you put forth, knowing it is your best. Do not look to those on the right or the left, just continue on your path and before you realize it, you will be a graduating nurse.

My other job is working as a nurse on a psychiatric floor at a local hospital. What troubled minds these patients have. It is so heart wrenching to see how years of physical and sexual abuse can destroy the life of a young man. One young man in particular took my heart. He could not have been more than 19 years of age. He confided in me that he had been abused by his foster care brother from the age of 8 to to the age of 11. My client was taken away from his mother at an early age because she physically abused him. How awful that he had to go from being physically abused to being sexually abused. It is not right. His mother is currently in an adult foster care home, and she calls him at the hospital. I watch him rocking back and forth on the phone stating that he doesn’t want to talk to to her. So I was walking by and asked him for the phone and stated that your son does not want to talk to you right now and hung up. I instructed my client to do the same thing when he felt that he was being assulted verbally. My client is very bright, he plays a mean game of spades, though if you ask him what his diagnoses is, he will tell you that he is mildly mentally retarded, bi-polar and autistic. He makes quick jerking actions from time to time. I sometimes wonder if that isn’t from the beatings that he recieved from his mother. No child should have to go through what he has gone through. Did I tell you why he was in the pshcyicatric ward? Well for one thing he has an anger problem. Can you guess why? He was in a group home and he threw a brinck through the window and got some of the other residents really mad. They in turn beat him up very badly. He has two huge black circles under his eyes. He has no control over his emotions, and lashes out at others without thinking. He became very anxious after he spoke with his girlfriend on the phone. He began lashing out verbally at others. I sat down with and asked him what was wrong. He first stated that he didn’ want to talk about it. i explained to him that he had a right to be angry, but that he shouldn’t take his anger out on others around him. That those people do not have anything against him and that he should take pause to identify where his anger is coming from. As I sat with him, he said, “I tell you why I am angry, it’s because my girlfriend doesn’t want to come and see me. No one wants to see me. (he begann to weep, pulling his T-shirt over his head so no one could see him cry) He continued, through his tears, I don’t have any family. I never had a mother who loved me. Why was I abused, hurt and beaten? (I was beginning to cry at this point.) Why can’t I find someone who loves me? As he wept, I put my hand on his back and told him the following, “You may not have had a family, but you are related to the world. Every person on earth is part of the family of humanity. I realize that you have not met good people, but believe me there are good caring people out there, with great love in their hearts. As far as finding someone who loves you, well I can tell you this, the reality is that not everyone that you feel you can care about will care equally for you. But the love that you have in your heart that allows you to care about others is a beautiful gift of emotion. You wil find that special someone who will care for you equally if not more. It may not be today or next week, but it will happen. You need to be patient, and know how special you are. You have not had good caring people in your life and yet you have this wonderful loving compassionate soul, in spite of all the horrible things that have happened to you. That is why you must be your best friend, and take care of yourself just like you would take care of someone that you love. (He continued to weep saying.,.) “If they make me go back to that group home, those guys will kill me, please don’t let them send me back, please. I will probably kill myself if they send me back.” ( I explained to him that he was no going to be sent back there, and that he would be allowed to manage some of his money and maybe get a partime job.) We sat there for an hour and talked about what his goals were. He explained that he wanted to get his high school equivalency, get a job and more than anything to live in peace. We hugged. I told him that if he ever had problems, where ever he was, to call the floor and ask for Nancy. I never told a client that before, but I meant it, and as this writing finds its way around the world for others to read I know that my promise will stand. For what is the worth of a man or women if they are not faithful to their word. In closing I would like to say this about the treatment of America’s mentally ill. They need our help and help. There is not enough supervision of adult group homes, and I fear for their quality of life and their immediate safety. We really do have a wonderful country. But we as Americans need to look up from our lap tops and truly see what is happening around us.

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